Peer Review Report For: Attitudes, barriers and enablers to dysphagia management among healthcare professionals: a mixed-methods systematic review protocol [version 2; peer review: 2 approved with reservations]

Introduction Dysphagia (swallowing difficulty) is a complex condition associated with adverse clinical outcomes, including malnutrition, dehydration, aspiration pneumonia, prolonged hospitalisation and reduced quality of life. Effective dysphagia management requires person-centred, evidence-informed care delivered through coordinated multidisciplinary service models across acute, rehabilitation, long-term care, and community settings. Healthcare professionals (HCPs) play a central role in dysphagia service delivery. However, variability in training, resources, interprofessional collaboration, and organisational structures may influence care quality. A comprehensive synthesis of HCPs’ attitudes, and perceived barriers and enablers to dysphagia management is needed to inform workforce development and service improvement. Methods This mixed-methods systematic review will be conducted using the Joanna Briggs Institute (JBI) convergent integrated approach. Six bibliographic databases (PubMed, CINAHL, Embase, PsycINFO, Web of Science, and the Cochrane Library) will be searched for primary studies published between 1 January 2012 and 1 June 2025. Studies published in English, Maltese, Italian, French, and Polish will be eligible. Targeted organisational reports from the Royal College of Speech and Language Therapists (RCSLT), American Speech-Language-Hearing Association (ASHA), National Institute for Health and Care Excellence (NICE), World Health Organization (WHO), and European Society for Swallowing Disorders (ESSD) will also be searched. Two reviewers will independently screen, extract, and appraise studies. Methodological quality will be assessed using the Mixed Methods Appraisal Tool (MMAT). Quantitative data will be transformed into textual descriptions and integrated with qualitative findings to produce synthesised themes. Discussion This review will provide an integrated understanding of professional-level and system-level influences on dysphagia service delivery. Findings are expected to inform workforce education, interprofessional collaboration, organisational policy, and person-centred care frameworks in dysphagia management. Registration PROSPERO CRD42022323414.